Guidelines For Case Selection, Continuance and Dismissal for Speech-Language Services Within Intermediate Unit 1
Eligibility and Dismissal Guidelines
One of the roles of the speech-language pathologist is to participate as a member of the evaluation team in identifying students who may be in need of assessments to determine possible eligibility for special education or related services. These assessments assist in determining the presence of disabilities and eligibility/ineligibility for special education and related services as defined under the Individuals with Disabilities Education Act (IDEA 2004), Federal Regulations, and Chapter 14 PA Regulations.
The basic phases of the identification process are pre-referral/screening and referral when indicated.
The pre-referral/screening process is the first step in deciding whether a student is in need of referral for a special education/related services evaluation or in need of program modifications within the regular education environment. Many schools establish educational problem-solving teams, with such names as Child Study Team or Instructional Support Team (IST). These teams are defined as school-based problem-solving groups whose purpose is to assist teachers with intervention strategies for dealing with the learning needs and interests of pupils before a formal referral for an evaluation is initiated.
Screening, by definition, is a process of selection/elimination of students for evaluation consideration. The screening process is completed through group or individual activities that (1) can be administered in a short period of time and (2) provides a limited sampling of specific speech and language skills. It may include commercially produced screening measures, non-standardized checklists, questionnaires, interviews, or observations administered and interpreted by the SLP. If and when it is the responsibility of the school-based speech-language pathologist to conduct the screenings, the speech-language pathologist:
- selects screening measures meeting standards for technical adequacy
- administers and/or interprets a speech-language screening
However, if a potential speech and language disability is identified during this screening by the speech and language pathologist, and strategies for classroom and parent are not successful, the student is referred for evaluation.
During the pre-referral phase, it is the responsibility of the speech-language pathologist, as a team participant, to provide one or more of the following services as appropriate for specific students:
- Review pertinent school records
- Review classroom modifications and interventions attempted
- Observe the student in the classroom
- Collaborate with parents, teachers, and other professionals to provide strategies, resources, and additional recommendations
- Demonstrate intervention strategies, procedures, and techniques
- Review classroom modifications and interventions attempted
- Provide follow-up consultation
- Gather additional data
Relevant guidance under Chapter 14 PA Regulations includes:
- (14.122) Screening
- Each school district shall establish a system of screening to accomplish the following:
- Identify and provide initial screening for students prior to referral for a special education evaluation.
- Provide peer support for teachers and other staff members to assist them in working effectively with students in the general education curriculum.
- Conduct hearing and vision screening.
- Identify students who may need special education services and programs.
- Each school district shall implement a comprehensive screening process.
- The screening process shall include:
- Curriculum-based or performance-based assessment.
- Student response to interventions
- Determination whether difficulties are due to lack of instruction or English Proficiency or both
- Determination whether student's needs exceed functional ability of the regular education program to maintain the student at an appropriate instructional level
- Activities to gain parent involvement
- If screening activities have produced little or no improvement within 60 school days after initiation, the student shall be referred for evaluation.
- Screening activities do not prohibit a parent from requesting an evaluation at any time, including prior to or during the screening process.
When accommodations and interventions have been attempted but have not been successful, a referral for assessment may be initiated by any individual, including a parent, teacher, or other service provider. The referral is a formal written request for assessment of a student with suspected special education needs. The assessment focuses on all areas related to a suspected disability that may result in eligibility for special education and/or related services. The written referral includes a brief description of any previously attempted supplementary aids and services, program modifications and supports to the general education environment, a statement regarding the effectiveness of those modifications, and a rationale for the assessment.
When the speech-language pathologist is a member of the Multidisciplinary Team, in accordance with local policies, it may be the responsibility of the speech-language pathologist to:
- Review referrals
- Participate in the development of the assessment plan
- Obtain the results of current hearing/vision screenings and monitor follow-up when appropriate
- Communicate with classroom teacher(s) and parent(s) regarding the status of the referral and to obtain their input
- Obtain written parent/guardian consent for evaluation in accordance with federal mandates, state guidelines, and local policy and procedures
- Complete and distribute the paperwork to process the referral
A core role of the school-based speech-language pathologist is to conduct a thorough and appropriate speech, language, or communication assessment. A distinction is made between the role of assessment and the role of evaluation. Assessment refers to data collection process and the gathering of evidence. Evaluation refers to deriving meaning from the data through interpretation, analysis and reflection.
A responsibility of the school-based speech-language pathologist is to select assessment measures that:
- are free of cultural and linguistic bias
- are appropriate for the student's age
- match the stated purpose of the assessment tool to the reported needs of the student
- describe differences when compared to peers
- describe the student's specific communication abilities and difficulties
- elicit optimal evidence of the student's communication competence
- describe real communication tasks
The role of the school-based speech-language pathologist is to evaluate the information gained from all assessment data and make informed decisions about eligibility or placement and subsequent intervention strategies.
The first step of the assessment phase is to develop an assessment plan within mandated timelines which documents the areas of speech and language to be assessed, the reason for the assessment, and the names and titles of the personnel who will conduct the assessment. If an initial screening was completed, the results are used to identify the specific areas of speech and language to be addressed.
During assessment data collection, it is the responsibility of the speech-language pathologist to select and conduct an appropriate assessment. This may include:
- Compiling a relevant student history (health, educational, social)
- Collecting descriptive, non-standardized data from parent(s), family, caregivers, teachers, other service-provider professionals and paraprofessionals
- Selecting and administering appropriate standardized assessment instruments, including alternative assessment strategies, when indicated
- Obtaining classroom (or other setting) observation of the student
Following screening, students having possible speech and language problems are further evaluated to determine eligibility for program enrollment and specific therapy needs. It is vital that the diagnostic evaluation be thorough and appropriate to the needs of the individual students. No single procedure may be used as the sole criterion for determining whether a child is a child with a disability and for determining an appropriate educational program for the child. Only when all of the information has been compiled and each component reviewed as an integral part of the total behavior of a particular student, is an SLP prepared to plan an IEP.
During assessment data collection, it is the responsibility of the speech-language pathologist to gather information, select appropriate assessment methods, and conduct a balanced assessment.
This balanced assessment may include:
- gathering information from parent(s), family, student, teachers, other service-provider professionals and paraprofessionals
- compiling a student history from interviews and thorough record review
- collecting student-centered, contextualized, performance-based, descriptive, and functional information
- selecting and administering reliable and valid standardized assessment instruments that meet psychometric standards for test specificity and sensitivity
A Collaborative Process
It is worth emphasizing that a speech and language evaluation is a team endeavor and is comprised of more than just individual test results. In order to demonstrate that the speech and language deviation has an adverse effect on educational performance, evaluation data must be collected from other members of the MDT. The teacher is the principle provider of information regarding the effect on educational performance.
As a member of the MDT, the teacher must offer information regarding the child's speech and language functioning level within the classroom. Important considerations should be 1) the child's ability to process information (academic and social information) and 2) the child's ability to express information, noting the quality and frequency of speech and language production. Teachers also provide specific information regarding listening, speaking, reading, writing, spelling/invented spelling, and the relationship between the student's communications skills and the curriculum. Teacher-classroom checklists can be used to structure the information collection process from teachers. Teacher Input forms for each speech and language disability are included in every section of the Severity Rating Scales.
The second necessary element is the opportunity for Parent Input. Parents can provide valuable information regarding the child's communicative behavior in various settings and provide additional information about functional and developmental communication levels. Both the Teacher Input and the Parent Input will give the SLP essential information regarding the child's communicative performance. The SLP should analyze this information to assist in selection of appropriate assessment instruments. The following section describes recommended procedures for the individual assessment portion of the Multidisciplinary Evaluation.
The speech-language pathologist collects relevant and accurate information through record review, observation, and parent, teacher, or student interviews. Information regarding the student's medical and family history, communication development, social-emotional development, academic achievement from previous education placements, language dominance, community/family language codes and social-behavioral functioning are especially valuable when completing a student case history.
Evaluation procedures must result in a description of the speech and language characteristics manifested by the student and the effect of the student's speech and language deficits on his/her educational performance.
When appropriately selected for validity and reliability, standardized tests yield important information regarding language and speech abilities and are part of the comprehensive assessment. They are norm-referenced and used to compare a specific student's performance with that of peers. Statistical scores are valid only for students who match the norming population described in the test manual.
Although all areas of speech, language, and communication are interrelated, broad spectrum, norm-referenced tests may be used to measure such skills of language comprehension and production as syntax, semantics, morphology, phonology, pragmatics, discourse organization, and following directions. Additional tests may be administered to assess such specific areas as auditory abilities and auditory processing of language. Tests are used to assess articulation, phonology, fluency, and voice/resonance; and instrumental and noninstrumental protocols are used to assess swallowing function.
No child should be considered eligible for speech and language services solely on the basis of standardized test results.
Criterion Referenced Assessment
Other assessments may be administered to provide more specific diagnostic or educational planning information. Criterion-referenced assessment may be conducted to determine exactly which specific speech-language skills have been acquired and which skills must be taught.
Another important area of non-normative assessment addressed by the SLP and assessment team is curriculum-based assessment. This approach extends the evaluation to consider the student's communication skills and deficits within the context of the communication demands of the curriculum and the educational environment.
Curriculum-based assessment addresses the following areas:
- The communication skills and strategies needed by the student to participate in the curriculum,
- The processes and strategies currently exhibited by the student when communicating with the educational environment,
- The new skills, strategies or compensatory techniques the student must acquire to be a more competent participant in the curriculum and educational environment, and
- The curricular modifications that will provide the student with greater opportunities to participate in the educational environment
Functional Communication Assessment
An additional group of students, who need assessment, are students with severe cognitive impairments. Very few standardized procedures exist that satisfactorily evaluate the communication skills of pre-verbal or non-verbal students. Therefore, it is necessary to employ structured observation, checklists, and interview techniques in determining the communication forms, functions, and intents of these students. Sometimes standardized assessments can be used in non-standardized ways or informal criterion scales can also be used to assist in planning for this population.
Other informal procedures may be administered to supplement the information obtained from norm-referenced assessments. For example checklists and developmental skills, portfolio assessment, and observation/anecdotal records may be used to help determine eligibility for services.
Multiple Samples of Communication Performance
It is important to sample target communication skills in multiple contexts and through varying elicitation techniques so that a valid and representative sample of the student's communication skills is obtained. This is the rationale for the collection of a spontaneous language sample as well as the requirement for demonstration of inadequate functioning on more than one test or sub-test. A spontaneous language sample is analyzed to determine if it provides corroborative evidence for the presence of a communication impairment.
Common Considerations for Eligibility
Cognition and language are intrinsically and reciprocally related in both development and function. An impairment of language may disrupt one or more cognitive processes; similarly, an impairment of one or more cognitive processes may disrupt language. Cognitive-based impairments of communication are referred to as cognitive-communication impairments and are disorders that result from deficits in linguistic and nonlinguistic cognitive processes. They may be associated with a variety of congenital and acquired conditions (ASHA, 1988;1991b). Speech-language pathologists are integral members of interdisciplinary teams engaged in the identification, diagnosis and treatment of persons with cognitive-communication impairments (ASHA, 1987). The role of the school speech-language pathologist in evaluating the communication needs of students with cognitive-communication impairments includes:
- collaborating with families, teachers, and others in locating and identifying children whose communication development and behavior may suggest the presence of cognitive impairments or whose communication impairments accompany identified cognitive impairments
- collaborating with other professionals to interpret the relationship between cognitive and communication abilities assessing communication requirements and abilities in the environments in which the student functions or will function [assessing the need for assistive technology
- including alternative/augmentative communication systems
Rejection of Cognitive Referencing
The practice of excluding students with language problems from eligibility for services when language and cognitive scores are commensurate has been challenged and criticized for more than a decade (ASHA, 1989). First, such comparisons are made based on norm-referenced tests. Second, cognitive referencing is based on the assumption that cognitive skills are prerequisites for language development, and that intelligence measures are a meaningful predictor of whether a child will benefit from language services. Third, scores across tests having different standardization populations and different theoretical bases cannot validly be compared (ASHA, 1989). Fourth, there are no "pure" measures of either verbal or nonverbal abilities; children with language difficulties exhibit problems with nonverbal tasks that could affect their IQ scores (Sattler, 1988), thereby leading to a convergence of test scores. Finally, cognitive referencing for children with cultural differences will be adversely affected by the linguistic bias, format, bias, and content bias prevalent in many formal tests (Taylor & Payne, 1983; Terrell, 1996).
IDEA does not require determination of a significant discrepancy between intellectual ability and achievement in order for a child to be eligible for services. In fact, categorical denial of services because of general developmental levels is inconsistent with IDEA's requirement that services be determined on an individual basis.
Determination of eligibility for services should not be made solely on the basis of a discrepancy between language and cognitive measures. Categorical denial without consideration of the student's unique needs and potential to benefit violates federal and state statute, regulation, and policy.
Use of Standardized Tests
While standardized tests are appropriate assessments as part of a comprehensive evaluation, it is inappropriate to use severity cut-off scores (e.g. 1.5 standard deviations below the normative group mean) as the sole determinant of eligibility. Severity cut-off scores can prove arbitrary when applied to a variety of norm-referenced tests. More importantly, this practice does not address the mandate of IDEA to serve children with disabilities because severity is not the sole determinant of whether a condition adversely affects educational performance. A comprehensive assessment should be individually designed and include an appropriate balance of formal and informal assessment instruments and procedures to identify areas of strength and weakness. This quantitative and qualitative assessment examines how the child functions communicatively in the environments in which he or she participates.
Adverse Effect on Educational Performance
The definition of speech or language impairment at the federal and state levels means, "a communication disorder, such as stuttering, impaired articulation, a language impairment or voice impairment that adversely affects a child's educational performance."
In order to be deemed a handicap, communication impairments must exert an adverse effect on educational performance. Educational performance refers to the student's ability to participate in the educational process, and must include consideration of the student's social, emotional, academic, and vocational performance. To the extent that a speech and language impairment affects the student's ability to participate in active, interactive communication with others in the educational setting, (including peers as well as adults), the student is prevented from participating in the process of education.
The definition of educational performance must not be limited solely to consideration of academic performance. The student does not need to be below grade level or failing in an academic area to be eligible as speech and language impaired. Examples of students who may be succeeding academically but are still eligible as speech and language impaired include the following:
- A bright student who is dysfluent and has related problems contributing to class discussions, giving book reports, and answering questions orally
- A first grader who is ahead of peers in many areas, but has non-developmental articulation errors that affect intelligibility during "show and tell", phonics instruction, and other educational activities requiring oral responses
- A third grader who is an above average reader, but whose voice disorder inhibits his/her classroom verbal interactions, resulting in reluctance to give book reports, do oral reading and join in class discussion
Another misconception is that any deviance in communication constitutes a handicap. A speech or language deviation does not necessarily constitute an adverse effect on the student's ability to function in the educational setting any more than deviations like mild muscle incoordination or poor eyesight necessarily interfere with educational functioning. Similarly, the speech and language deviation must be shown to interfere with the student's ability to perform in the educational setting before Speech and Language Impaired eligibility is determined.
The effect of the speech and language deviation on social/emotional development also must be carefully considered. The key issue to be addressed is whether the deviation interferes with the student's ability to establish and maintain social relationships and experience sound emotional development. Self consciousness about a speech or language deviation or teasing by peers does not by itself necessarily constitute an impediment to social relationships and emotional development. Careful documentation of limitations of social relationships and sound emotional development must be directly linked with the speech and language deviation to establish the existence of an adverse effect on educational performance.
The documentation of effect on educational performance must clearly indicate two things: the manner in which the student's communication deficit affects his/her performance in the educational setting, and the adverse nature of the effect.
Documentation of the effect on educational performance can be obtained by having the regular education teacher complete a checklist detailing behaviors of the student in the classroom that may indicate an adverse effect on educational performance.
Within this document are suggested checklists to document adverse educational effect related to aural/oral communication.
Use of individual professional judgment is essential in determining a severity rating and many clinical judgment factors should be considered such as those that are part of the Iowa Severity Rating Scales for Communication Disabilities.
Clinical judgment factors to be considered:
- The consistency of the inappropriate communication patterns. (How consistent are the specific errors?)
- The pupil's ability to interact verbally with others. (This would include peer group, teachers, family members.)
- The effect of the communication problem on school performance.
- The impact of the communication problem on the listener.
- The ability of the student to communicate well enough to satisfy his/her needs.
- The status of speech and language stimulation in the home. (Is there much speech & language in the home? How much do family members communicate with each other? Is there sharing of information? Do parents talk with their children or to them?)
- The age of the child presenting the problem.
- The length of time the problem has existed in its current state
One cannot use a criteria & severity rating without also using individual professional judgment. All of these provide an effective combination for the determination of eligibility and need for speech-language support services. A student may not strictly meet the established eligibility criteria, yet team members believe that the student has a disability that adversely affects educational performance and requires special services. In such instances, the team should be allowed to use professional judgment to determine eligibility. Documentation should include a description of the informal and formal measures used to make the determination.
A communication rating scale reflects communication skills on a continuum, ranging from adequate on one extreme to inadequate at the other. Along that continuum, communication impairments can be classified from mild to severe. This classification process integrates descriptive information about the student's communication skills and their effect on educational performance.
The rating scales may be used as guidelines in recommending eligibility for speech-language services and the need for specially-designed instruction.
They can also assist in recommending the combination and intensity of programs, services and other resources that may be instituted to enable the student to succeed in his/her educational program. It is recommended that a flexible, multidisciplinary, and cooperative approach be adopted in planning for children with communication impairments. A classification along the continuum provides additional information that facilitates the educational planning process.
The Communication Rating Scales in the following sections of these guidelines can be used to make a classification of severity. Separate rating scales are provided for Articulation, Phonological Processes, Fluency, Language, and Voice. Even though some students may manifest communication impairments in more than one area, it is necessary to rate the student on only one scale. The scale chosen should reflect the impairment area that most adversely affects the student's communication performance. However, in making recommendations for speech-language services, the existence of multiple areas of communication impairment should be considered.
Service Delivery Model
"Service delivery is a dynamic concept and should change as the needs of the students change. No one service delivery model should be used exclusively during treatment." (ASHA, 1999)
Service delivery to students is the most visible part of IDEA 2004 and is the SLP's most important role with students who have identified communication disorders. Good service delivery systems will allow the SLP to comply with the requirements in IDEA 2004 for a continuum of options, services in the least restrictive environment, and provision for access to the general education curriculum.
The IEP team determines the student's needs as well as the service delivery model. Specific consideration in determining need and type(s) of service delivery models are:
- the severity of the communication impairment
- the effect of the communication impairment on the student's classroom performance and social integration
- the presence of confounding difficulties such as learning disability or hearing impairment
- the age and stage of the student's communicative development (ASHA. 1984)
- the current level of support available to the child
The SLP is not the only person to address communication goals with a student in school. Some students will receive service from a low ratio special education teacher or the non-categorical special education teacher. The SLP may evaluate the student and assist in the development of goals and then support these above mentioned school personnel as they work directly with the child who is communicatively impaired.
Using a variety of service delivery models allows the SLP to plan intervention and services to meet individual needs of students, to collaborate with other educational professionals, and to maximize effectiveness of therapy services with students.
There are a variety of service delivery categories through which students receive services. The arrangement of time, resources, location of service, and collaboration among educators comprise the service delivery model/s that will best meet individual student needs. Some service delivery options are as follows:
- The SLP sees the student for a specified amount of time per grading period to monitor or "check" on the student's speech-language skills. Often this model immediately precedes dismissal.
- Collaborative Consultation:
- The SLP, regular and/or special education teacher(s), and parents/families work together to facilitate a student's communication and learning in educational environments. In this indirect model, the SLP does not provide direct service to the student, but provides guidance and strategies to other team members.
- Classroom Based:
- This model is also known as integrated services, curriculum-based, transdisciplinary, interdisciplinary, or inclusive programming. This is an emphasis on the SLP providing direct services to students within the classroom and other natural environments. Team-teaching by the SLP and the regular and/or special education teacher(s) is frequent with this model. The SLP provides curriculum-based intervention while using materials from the classroom in the least restrictive environment. There are a variety of service delivery configurations included in the classroom-based service delivery model: team teaching, complementary teaching, supportive teaching, parallel teaching, remedial teaching, and station teaching.
- Services are provided to students individually and/or in small groups within the speech-language therapy room or a setting other than the classroom. However, some SLPs may prefer to provide individual or small group services within the physical space of the classroom. This model may be provided as one of following:
- Individual "pull-out" - Individual intervention. Takes place in speech room or within the physical space of the classroom by SLP.
- Group "pull-out" - Small group intervention. Takes place in speech room or within the physical space of the classroom by SLP. (2-5 students)
- Individual and group "pull-out" - Combination of above.
- Individual "pull-out" and classroom - Both individual "pull-out" services and classroom based intervention by the SLP.
- Group "pull-out" and classroom - Both group "pull-out" services and classroom based intervention by the SLP.
- Group/individual "pull-out" and classroom - Both individual and group "pull-out" services and classroom based intervention by the SLP.
- Community Based:
- Communication services are provided to students within the community setting. Goals and objectives focus primarily on functional communication skills.
- The SLP provides two or more service delivery options.
This list is by no means "exhaustive" and the combinations/models are limited only by the imagination of the team members working with the student. Decisions should be based on student needs(s). It may be helpful to review the model options prior to the IEP development.
Consider appropriate model, frequency and length of therapy sessions based on:
- Type and severity of communication disorder(s)
- The functioning level of the student
- The length of time the student has been in therapy
- Amount of time student spends out of the classroom while in support services
Remember: As the student's needs change and skills develop, the appropriateness of the service delivery, frequency and length must be re-evaluated and adjusted accordingly. A student may be served in more than one type of service delivery model during the course of his/her individualized program.
It is important for the speech-language pathologist to use sound professional judgment and competency in recommending that services for an eligible student are no longer warranted. When considering dismissal, a reevaluation is necessary if the student will no longer be receiving special education services as a student who is speech-language impaired only. The student's IEP Team must review all data to determine if the student is no longer eligible for speech and language support services. The permission to reevaluate is issued only if additional data is needed. Parents must be part of this decision making process. The decision to dismiss is based upon IEP Team input (i.e., parents, teacher, specialist(s), etc.) initiated by the SLP or any other team member. If progress is not observed over time, changes must be made in the interventions/accommodations. If continued lack of progress is shown, specific goals and intervention approaches must be re-examined. If additional progress is not observed, dismissal may be warranted. If it can be determined that continued speech therapy would not greatly improve educationally-based speech and language skills of students with severely impaired communication or cognitive systems, and no specific articulation needs remain, dismissal should be considered. The student's current academic level, behavioral characteristics and impact on educational performance should be considered when determining dismissal.
If speech and language services are provided as a related service under another disability category such as autism, other health impairment, mental retardation, etc, eligibility for special education services will still apply and other services will continue and eligibility will not be changed. The Dismissal/Exit Criteria Articulation Form may be used as a guide when making the determination to discontinue services. Such decisions must be documented in the IEP Present Education Level and reflected throughout the IEP where appropriate. Parents must be involved in this decision to discontinue speech and language support services as a related service.
Remember, if the speech and language services are provided under the disability category of speech and language impairment, the reevaluation process must be completed.Continue to Articulation/Phonological Processes »